Craig Leve’s research while affiliated with Oregon Research Institute and other places

Maternal depressive symptoms are associated with elevations in harsh parenting behavior, including criticism, negative affect, and hostile or coercive behavior, and these behaviors contribute to associations between maternal depressive symptomatology and child functioning. We used multilevel survival analysis to examine social–cognitive processes as proximal predictors of the onset and offset of maternal aggressive behavior during interactions with their adolescent children. Low-income women (N = 180) were selected for either: (a) elevated depressive symptoms and a history of treatment for depression (depressed group) or (b) not more than mild levels of current depressive symptomatology, no history of depression treatment, and no current mental health treatment (nondepressed group). These women and their adolescent children (ages 11–14, M = 12.93; 96 male sex, as assigned at birth) participated in a dyadic problem-solving interaction and mothers completed a video-mediated recall procedure, in which they watched a segment of the interaction, labeled their adolescents’ affect, and made attributions for their behavior. Mothers in the depressed group were more likely to initiate aggressive behavior and, once initiated, were less likely to transition out of it. Mothers in both groups were less likely to transition out of aggressive behavior when they made negative attributions for their adolescents’ behavior. Findings point to promising cognitive and behavioral targets for intervention.

Parenting styles associated with maternal depression are a risk factor for adolescent psychopathology, and maternal attributional styles may be a key mechanism in this relationship. Mother-adolescent dyads (N = 180; 96 male; ages 10-15) completed in-person interactions and then the mothers participated in a video-mediated recall procedure to assess maternal attributions. Maternal depression was associated with negative attributions. Negative attributions were associated with low parental acceptance, aggressive parenting, and low positive parenting. Positive maternal attributions were associated with less aggressive parenting, and more positive parenting during one interaction task. Adolescent externalizing behaviors were associated with negative attributions. Future research should evaluate whether maternal attributions mediate the association between maternal depression and both parenting behaviors and adolescent mental health.

IntroductionImplicit bias can lead medical professionals in Neonatal Intensive Care Units (NICUs) to disregard mothers who are Black and economically disadvantaged as they advocate for their infants’ health. Disregard can weaken underlying communication principles within the Family-Centered Care (FCC) model of pediatric health in NICUs and increase maternal distress. This study is the first to address communication disregard by examining mothers’ perceived power and efficacy of voice with NICU doctors and nurses. We hypothesized that mothers who are Black and economically disadvantaged would report lower efficacy of voice and higher levels of distress as compared to White mothers with higher income.Methods During pre-assessment within a small clinical trial of a parenting intervention, 33 racially and economically diverse mothers, from three Midwest NICUs serving the urban poor, responded to a 14-item measure of maternal power and efficacy of voice and measures of somatization, depression, anxiety and eating/sleeping disorders. Nonparametric examinations assessed the relation of power and efficacy of voice to maternal race, income, and distress.ResultsIn contrast to White, higher-income mothers, Black, economically disadvantaged mothers reported lower perceived efficacy of voice with doctors (U = 74.5, d = 0.65) and nurses (U = 74.0; d = .0.66). These mothers with lower perceived efficacy with doctors and nurses, reported higher levels of somatization (U = 16.5, d = 1.14; U = 13.5, d = 1.38, respectively) and eating disorders (U = 14.0, d = 1.29; U = 12.0, d = 1.48, respectively).DiscussionStudy results are discussed within the framework of implicit bias in FCC in the NICU, expanding our understanding of effective communication with economically stressed, Black mothers.

Background Justice-involved youth are especially vulnerable to mental health distress, substance misuse, and risky sexual activity, amplifying the need for evidence-based programs (EBPs). Yet, uptake of EBPs in the justice system is challenging because staff training is costly in time and effort. Hence, justice-involved youth experience increasing health disparities despite the availability of EBPs. Objective To counter these challenges, this study develops and pilot-tests a prototype of a technology-based training tool that teaches juvenile justice staff to deliver a uniquely tailored EBP for justice-involved youth—PHAT (Preventing HIV/AIDS Among Teens) Life. PHAT Life is a comprehensive sex education, mental health, and substance use EBP collaboratively designed and tested with guidance from key stakeholders and community members. The training tool addresses implementation barriers that impede uptake and sustainment of EBPs, including staff training and support and implementation costs. Methods Staff (n=11) from two juvenile justice settings pilot-tested the technology-based training tool, which included five modules. Participants completed measures of HIV and sexually transmitted infection (STI) knowledge, sex education confidence, and implementation outcomes such as training satisfaction, adoption, implementation, acceptability, appropriateness, and sustainability. PHAT Life trainers assessed fidelity through two activity role plays participants submitted upon completing the training modules. Results Participants demonstrated increases in HIV and STI knowledge (t10=3.07; P=.01), and were very satisfied (mean 4.42, SD 0.36) with the training tool and the PHAT Life curriculum. They believed that the training tool and curriculum could be adopted, implemented, and sustained within their settings as an appropriate and acceptable intervention and training. Conclusions Overall, the results from this pilot test demonstrate feasibility and support continuing efforts toward completing the training tool and evaluating it within a fully powered randomized controlled trial. Ultimately, this study will provide a scalable option for disseminating an EBP and offers a more cost-effective and sustainable way to train staff in an EBP.

Infants of low-income and depressed mothers are at high risk for poor developmental outcomes. Early parenting mediates infant experiences from birth, and early intervention can support sensitive and responsive parent practices that optimize infant outcomes via promoting developmental competencies. However, low-income and depressed mothers experience substantial challenges to participating in early intervention. They also have extremely limited access to interventions targeting depression. Interventions targeting maternal depression and parent practices can improve maternal and infant outcomes. Mobile internet-based interventions overcome numerous barriers that low-resource mothers face in accessing home-based interventions. Pandemic-related stressors likely reduce family resources and exacerbate distress of already heavily-burdened mother-infant dyads. During crises such as the COVID-19 pandemic, evidence-based remote coaching interventions are paramount. This article reports on a mobile intervention for improving maternal mood and increasing parent practices that promote infant development. An ongoing randomized controlled trial study provided a unique opportunity to monitor progression from referral to intervention initiation between two groups of depressed mothers: those prior to the pandemic and during the pandemic. The study also examines mother and infant characteristics at baseline. The sample consisted primarily of Black mothers experiencing extreme poverty who self-referred to the study in a large southern city, which is one of the most income disparate in the United States. Prior to the pandemic, 97% of study participants successfully progressed from consent to intervention, as compared to significantly fewer–86%–during the pandemic. Mother-infant dyads during COVID-19, as compared to those prior to COVID-19, displayed similar pre-intervention demographic characteristics and intrapersonal characteristics.

https://www.frontiersin.org/articles/10.3389/fpsyg.2021.719149/abstract

Background Postpartum depression interferes with maternal engagement in interventions that are effective in improving infant social-emotional and social-communication outcomes. There is an absence of integrated interventions with demonstrated effectiveness in both reducing maternal depression and promoting parent-mediated practices that optimize infant social-emotional and social-communication competencies. Interventions targeting maternal depression are often separate from parent-mediated interventions. To address the life course needs of depressed mothers and their infants, we need brief, accessible, and integrated interventions that target both maternal depression and specific parent practices shown to improve infant social-emotional and social-communication trajectories. Objective The aim of this study is to evaluate the efficacy of a mobile internet intervention, Mom and Baby Net, with remote coaching to improve maternal mood and promote parent practices that optimize infant social-emotional and social-communication development. Methods This is a two-arm, randomized controlled intent-to-treat trial. Primary outcomes include maternal depression symptoms and observed parent and infant behaviors. Outcomes are measured via direct observational assessments and standardized questionnaires. The sample is being recruited from the urban core of a large southern city in the United States. Study enrollment was initiated in 2017 and concluded in 2020. Participants are biological mothers with elevated depression symptoms, aged 18 years or older, and who have custody of an infant less than 12 months of age. Exclusion criteria at the time of screening include maternal homelessness or shelter residence, inpatient mental health or substance abuse treatment, or maternal or infant treatment of a major mental or physical illness that would hinder meaningful study participation. Results The start date of this grant-funded randomized controlled trial (RCT) was September 1, 2016. Data collection is ongoing. Following the institutional review board (IRB)–approved pilot work, the RCT was approved by the IRB on November 17, 2017. Recruitment was initiated immediately following IRB approval. Between February 15, 2018, and March 11, 2021, we successfully recruited a sample of 184 women and their infants into the RCT. The sample is predominantly African American and socioeconomically disadvantaged. Conclusions Data collection is scheduled to be concluded in March 2022. We anticipate that relative to the attention control condition, which is focused on education around maternal depression and infant developmental milestones with matching technology and coaching structure, mothers in the Mom and Baby Net intervention will experience greater reductions in depression and gains in sensitive and responsive parent practices and that their infants will demonstrate greater gains in social-emotional and social-communication behavior. Trial Registration ClinicalTrials.gov NCT03464630; https://clinicaltrials.gov/ct2/show/NCT03464630 International Registered Report Identifier (IRRID) DERR1-10.2196/31072

BACKGROUND Postpartum depression interferes with maternal engagement in interventions shown to be effective in improving infant social-emotional and communication outcomes. There is an absence of integrated interventions with demonstrated effectiveness in both reducing maternal depression and promoting parent-mediated practices that optimize infant social-emotional and communication competencies. Interventions targeting maternal depression are often separate from parent-mediated interventions. To address the life course needs of depressed mothers and their infants, we need brief, accessible, and integrated interventions that target both maternal depression and specific parent practices shown to improve infant social-emotional and communication trajectories. OBJECTIVE Evaluate the efficacy of a mobile internet intervention, Mom and Baby Net (MBN), with remote coaching to improve maternal mood and promote parent practices that optimize infant social-emotional and communication development. METHODS This is a 2-arm, randomized controlled, intent-to-treat trial. Primary outcomes include maternal depression symptoms and observed parent and infant behavior. Outcomes are measured via direct observational assessment and standardized questionnaires. The sample is being recruited within the urban core of a large southern city in the U.S. Study enrollment was initiated in 2017 and concluded in 2020. Participants are biological mothers with elevated depression symptoms, 18 years of age or older, who have custody of an infant less than 12 months of age. Exclusion criteria at the time of screening include maternal homelessness or shelter residence, inpatient mental health and/or substance abuse treatment, or maternal or infant treatment of a major mental or physical illness that would hinder meaningful study participation. RESULTS The start date of this grant-funded randomized controlled trial was September 1, 2016. Data collection is underway. Following IRB-approved pilot work, the randomized controlled trial was IRB- approved on November 17, 2017. Immediately following IRB approval, recruitment was initiated. Between February 15, 2018 and March 11, 2021, we successfully consented a sample of 184 women and their infants into the randomized controlled trial. The sample is predominantly African American and socioeconomically disadvantaged. CONCLUSIONS Data collection is scheduled to conclude in March 2022. We anticipate that relative to the attention control condition, which is focused on education around maternal depression and infant developmental milestones with matching technology and coaching structure, mothers in the MBN intervention will experience greater reductions in depression and gains in sensitive and responsive parent practices, and that their infants will demonstrate greater gains in social-emotional and communication behavior. CLINICALTRIAL Clinicaltrials.gov, identifier NCT03464630, https://clinicaltrials.gov/ct2/show/NCT03464630

BACKGROUND Justice-involved youth are especially vulnerable to mental health distress, substance misuse, and risky sexual activity, amplifying the need for evidence-based programs (EBPs). Yet, uptake of EBPs in the justice system is challenging because staff training is costly in time and effort. Hence, justice-involved youth experience increasing health disparities despite the availability of EBPs. OBJECTIVE To counter these challenges, this study develops and pilot-tests a prototype of a technology-based training tool that teaches juvenile justice staff to deliver a uniquely tailored EBP for justice-involved youth—PHAT (Preventing HIV/AIDS Among Teens) Life. PHAT Life is a comprehensive sex education, mental health, and substance use EBP collaboratively designed and tested with guidance from key stakeholders and community members. The training tool addresses implementation barriers that impede uptake and sustainment of EBPs, including staff training and support and implementation costs. METHODS Staff (n=11) from two juvenile justice settings pilot-tested the technology-based training tool, which included five modules. Participants completed measures of HIV and sexually transmitted infection (STI) knowledge, sex education confidence, and implementation outcomes such as training satisfaction, adoption, implementation, acceptability, appropriateness, and sustainability. PHAT Life trainers assessed fidelity through two activity role plays participants submitted upon completing the training modules. RESULTS Participants demonstrated increases in HIV and STI knowledge ( t ₁₀=3.07; P =.01), and were very satisfied (mean 4.42, SD 0.36) with the training tool and the PHAT Life curriculum. They believed that the training tool and curriculum could be adopted, implemented, and sustained within their settings as an appropriate and acceptable intervention and training. CONCLUSIONS Overall, the results from this pilot test demonstrate feasibility and support continuing efforts toward completing the training tool and evaluating it within a fully powered randomized controlled trial. Ultimately, this study will provide a scalable option for disseminating an EBP and offers a more cost-effective and sustainable way to train staff in an EBP.

Background: Neonatal intensive care unit (NICU) history, combined with systemic inequities for mothers of nondominant cultures and mothers who are socioeconomically disadvantaged, places infants at an extraordinary risk for poor developmental outcomes throughout life. Although receipt of early intervention (EI) is the best single predictor of developmental outcomes among children with and at risk for early developmental delays, mothers and infants with the greatest needs are least likely to receive EI. Mobile internet-based interventions afford substantial advantages for overcoming logistical challenges that often prevent mothers who are economically disadvantaged from accessing EI. However, the bridge from the NICU to a mobile internet intervention has been virtually unexplored. Objective: This study aims to examine progression flow from NICU exit referral to an early mobile internet intervention to increase EI access and promote parent mediation of infant social-emotional and communication development. Methods: Three NICUs serving the urban poor in a Midwestern city were provided support in establishing an electronic NICU exit referral mechanism into a randomized controlled trial of a mobile internet intervention for mothers and their infants. Measurement domains to reflect the bridge to service included each crucial gateway required for navigating the path into Part C EI, including referral, screening, assessment, and intervention access. An iterative process was used and documented to facilitate each NICU in establishing an individualized accountability plan for sharing referral materials with mothers before their NICU exit. Subsequent to the referral, progression flow was documented on the basis of a real-time electronic recording of service receipt and contact records. Mother and infant risk characteristics were also assessed. Descriptive analyses were conducted to summarize and characterize each measurement domain. Results: NICU referral rates for EI were 3 to 4 times higher for open-shared versus closed-single gatekeeper referral processes. Of 86 referred dyads, 67 (78%) were screened, and of those screened, 51 (76%) were eligible for assessment. Of the 51 assessment-eligible mothers and infants, 35 dyads (69%) completed the assessment and 31 (89%) went on to complete at least one remote coaching intervention session. The dyads who accessed and engaged in intervention were racially and ethnically diverse and experiencing substantial adversity. Conclusions: The transition from the NICU to home was fraught with missed opportunities for an EI referral. Beyond the referral, the most prominent reason for not participating in screening was that mothers could not be located after exiting the NICU. Stronger NICU referral mechanisms for EI are needed. It may be essential to initiate mobile interventions before exiting the NICU for maintaining post-NICU contact with some mothers. In contrast to a closed, single point of referral gatekeeper systems in NICUs, open, shared referral gating systems may be less stymied by individual service provider biases and disruptions.